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Acute interstitial nephritis with membranous nephropathy in bucillamine-treated rheumatoid arthritis
Naoki Takamatsu1, Hideki Takizawa2, Hirohito Sugawara2
1Department of General Internal Medicine, Teine Keijinkai Hospital, 1-12, Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan. naokitakamatsu@hotmail.com.
Abstract:
In bucillamine-treated patients, persistent proteinuria caused by membranous nephropathy (MN) is a major adverse effect affecting the kidneys. We experienced a case of acute interstitial nephritis (AIN) with MN caused by bucillamine. An 81-year-old Japanese woman with a past medical history of rheumatoid arthritis and hypertension presented with a fever, epigastric pain, and nausea of 1 week's duration. She had commenced bucillamine 4 months earlier. At the time of admission, her baseline creatinine (0.8 mg/dl) had risen to 6.8 mg/dl. A renal biopsy revealed AIN with concomitant MN. Renal function gradually improved after bucillamine administration was stopped. In addition to MN, bucillamine can cause AIN, which requires a renal biopsy for definitive diagnosis. Given the host of pathological findings that tend to develop in patients using bucillamine, patients receiving the drug who present with symptoms of acute kidney injury should undergo a renal biopsy to determine the presence of AIN.
Insights
Bucillamine can cause acute interstitial nephritis (AIN) alongside membranous nephropathy (MN), a serious kidney issue. Prompt renal biopsy is crucial for diagnosing AIN in patients experiencing acute kidney injury while on bucillamine.
Area of Science:
- Nephrology
- Pharmacology
- Pathology
Background:
- Membranous nephropathy (MN) causing persistent proteinuria is a known adverse effect of bucillamine treatment.
- Acute interstitial nephritis (AIN) is another potential kidney complication associated with bucillamine use.
Purpose of the Study:
- To report a case of acute interstitial nephritis (AIN) co-occurring with membranous nephropathy (MN) in a patient treated with bucillamine.
- To highlight the importance of considering AIN as a differential diagnosis in bucillamine-treated patients presenting with acute kidney injury.
Main Methods:
- Case report of an 81-year-old Japanese woman treated with bucillamine for rheumatoid arthritis.
- Clinical presentation included fever, epigastric pain, nausea, and a significant rise in serum creatinine.
- Renal biopsy was performed, revealing acute interstitial nephritis (AIN) with concomitant membranous nephropathy (MN).
Main Results:
- The patient presented with acute kidney injury (creatinine rise from 0.8 to 6.8 mg/dl).
- Renal biopsy confirmed the presence of both AIN and MN.
- Cessation of bucillamine administration led to gradual improvement in renal function.
Conclusions:
- Bucillamine can induce not only MN but also AIN, necessitating a definitive diagnosis via renal biopsy.
- Patients on bucillamine experiencing symptoms of acute kidney injury should undergo renal biopsy to rule out AIN.
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